CRITICAL CARE REGISTERED NURSE {CCRN} PEDIATRICS
CERTIFICATION EXAM STUDY GUIDE | 2025–2026 UPDATED
REVIEW | TEST BANK 400 VERIFIED PRACTICE QUESTIONS & HIGH-
YIELD ANSWERS
Master the critical details of pediatric neurologic emergencies with this focused
CCRN-P guide. You’ll review when to give Mannitol for increased ICP, how to
interpret Cushing’s triad, identify early signs of shunt malfunction, and
recognize CSF leakage as a sign of basilar skull fracture. Learn key differences
in infant vs. older child airway anatomy, how to size oral airways, and how to
calculate CPP (Cerebral Perfusion Pressure) using MAP and ICP. This guide also
covers apnea testing, brain death confirmation, spinal reflexes, and SIADH-
related cerebral edema. Perfect for exam prep and bedside application in
pediatric critical care.
Which of the following is true concerning oral airways?
- They should only be used when gag reflex is not intact
- They should never be left in place after intubation
- To determine proper size, the airway is estimated from the tip of the nose to the angle of
the jaw
- When placed properly the airway should extend from the lips to just over the tongue
They should only be used when gag reflex is not intact
They can be left in place after intubation to prevent ETT biting, oral airways are measured from
corner of mouth to angle of the jaw, and should extend from lips to pharynx when placed properly
The nurse is caring for an infant with a closed head injury. His vital signs at 2:00 are BP 90-60 HR 130
RR 22 At 2:30 his vs are BP 110/42 HR 54 RR 2. In addition to attending to his airway, which of the
following should the nurse anticipate as a priority?
a. Admin 10ml/kg isotonic bolus
b. Admin prn Morphine
c. Admin Mannitol
d. Admin glucose
c. Admin Mannitol
Cushing's triad is anemergency where increased ICP may lead to herniation.
o Systolic BP increases (side pulse pressure)
o Bradycardia
, o apnea/abnormal resp.
Increased ICP is usually managed with Mannitol or 3%
Intubation of an infant can be more challenging due to physiological differences. Which of the
following I an accurate statement regarding an infant's airway in comparison to that of an older
child?
a. the epiglottis is shorter and floppy
b. The epiglottis extends over the larynx at a 90 degree angle
c. The epiglottis is more anterior
d. The widest part of the infant's airway is the cricoid cartilage ring
c. the infant's epiglottis is more anterior
The epiglottis is longer and floppy, extends over the larynx at a 45 degree angle. The narroewst part
of the infant's airway is cricoid cartilage ring.
The nurse is caring for a 5 year old with a closed head injury. When the nurse stimulates her, the
child flexes her arms, clenches her fist, and extends her legs. Which of the following is accurate?
a. The child is demonstrating decorticate posturing which indicate cerebral damage
b. The child is demonstrating decorticate posturing which indicates damage to the midbrain
c. The child is demonstrating decerebrate posturing which indicates cerebral damage
d. The child is demonstrating decerebrate posturing which indicates damage to the midbrain
The child is demonstrating decorticate posturing which indicate cerebral damage
A child is in the PICU after having a brain tumor resected. His ICP is 15 and his MAP is 80. What is his
CPP?
a. 95mmHg
b. 45mmHg
c. 65mmHg
,d. 22mmHg
c. 65mmHgc.
CPP = MAP - ICP
Which of the following is true regarding diagnosing brain death?
a. The body temperature must be greater than 33c
b. A diagnosis of brain death can still be made if the child is receiving CNS depressants and
stimulants
c. Spinal reflexes may still be present
d. No solid criteria exist for diagnosing brain death in children
c. Spinal reflexes may still be present
The body temp must be > 36
The neurologist is assessing a child for brain death. When the head is turned from side to side, the
nurse notes that she has a "dolls eyes" response. In the neurologically intact child when the head is
turned rapidly from side to side the eyes should:
a. deviate to the opposite side that the head is turned to
b. deviate to the same side that the head is turned to
c. open and close in rapid succession
d. close tightly
deviate to the opposite side that the head is turned to
An apnea test is considered positive if which of the following are present?
a. Resp effort is made when the PCO2 > 60 mmHg
b. Resp effort is made when the PCO2 < 60 mmHg
c. No resp effort is made when the PCO2 > 60 mmHg
d. No resp effort is made when the PCO2 < 60 mmHg
, c. No resp effort is made when the PCO2 > 60 mmHg
It is also considered + if no resp effort despite rise in PCO2 20 mmHg above baseline
In addition to altering fluid and electrolyte balance, SIADH is a concern in the neurosurgical patient
because it can lead to:
a. Cerebral edema
b. Massive intravascular volume depletion
c. Cerebral hypernatremia
d. Altered level of consciousness
a Cerebral edema
SIADH causes hyponatremia which can lead to cerebral edema
The nurse is caring for a 12yr with hydrocephalus who is being evaluated for shunt malfunction.
Which of the following is considered to be an early sign of increased ICP?
a. Alteration in LOC
b. Changes in reactivity of pupils
c. Changes in RR
d. Changes in HR
Alteration in LOC
An alteration in LOC is considered to be the earliest sign of increased ICP.
Which of the following is a true statement concerning TBIs?
a. Concussions always involve loss of consciousness
b. Diffuse cerebral edema is due to decreased blood volume
c. Cerebral lacerations are often associated with skull fractures
d. Skull fractures are examples of secondary injuries
c. Cerebral lacerations are often associated with skull fractures
CERTIFICATION EXAM STUDY GUIDE | 2025–2026 UPDATED
REVIEW | TEST BANK 400 VERIFIED PRACTICE QUESTIONS & HIGH-
YIELD ANSWERS
Master the critical details of pediatric neurologic emergencies with this focused
CCRN-P guide. You’ll review when to give Mannitol for increased ICP, how to
interpret Cushing’s triad, identify early signs of shunt malfunction, and
recognize CSF leakage as a sign of basilar skull fracture. Learn key differences
in infant vs. older child airway anatomy, how to size oral airways, and how to
calculate CPP (Cerebral Perfusion Pressure) using MAP and ICP. This guide also
covers apnea testing, brain death confirmation, spinal reflexes, and SIADH-
related cerebral edema. Perfect for exam prep and bedside application in
pediatric critical care.
Which of the following is true concerning oral airways?
- They should only be used when gag reflex is not intact
- They should never be left in place after intubation
- To determine proper size, the airway is estimated from the tip of the nose to the angle of
the jaw
- When placed properly the airway should extend from the lips to just over the tongue
They should only be used when gag reflex is not intact
They can be left in place after intubation to prevent ETT biting, oral airways are measured from
corner of mouth to angle of the jaw, and should extend from lips to pharynx when placed properly
The nurse is caring for an infant with a closed head injury. His vital signs at 2:00 are BP 90-60 HR 130
RR 22 At 2:30 his vs are BP 110/42 HR 54 RR 2. In addition to attending to his airway, which of the
following should the nurse anticipate as a priority?
a. Admin 10ml/kg isotonic bolus
b. Admin prn Morphine
c. Admin Mannitol
d. Admin glucose
c. Admin Mannitol
Cushing's triad is anemergency where increased ICP may lead to herniation.
o Systolic BP increases (side pulse pressure)
o Bradycardia
, o apnea/abnormal resp.
Increased ICP is usually managed with Mannitol or 3%
Intubation of an infant can be more challenging due to physiological differences. Which of the
following I an accurate statement regarding an infant's airway in comparison to that of an older
child?
a. the epiglottis is shorter and floppy
b. The epiglottis extends over the larynx at a 90 degree angle
c. The epiglottis is more anterior
d. The widest part of the infant's airway is the cricoid cartilage ring
c. the infant's epiglottis is more anterior
The epiglottis is longer and floppy, extends over the larynx at a 45 degree angle. The narroewst part
of the infant's airway is cricoid cartilage ring.
The nurse is caring for a 5 year old with a closed head injury. When the nurse stimulates her, the
child flexes her arms, clenches her fist, and extends her legs. Which of the following is accurate?
a. The child is demonstrating decorticate posturing which indicate cerebral damage
b. The child is demonstrating decorticate posturing which indicates damage to the midbrain
c. The child is demonstrating decerebrate posturing which indicates cerebral damage
d. The child is demonstrating decerebrate posturing which indicates damage to the midbrain
The child is demonstrating decorticate posturing which indicate cerebral damage
A child is in the PICU after having a brain tumor resected. His ICP is 15 and his MAP is 80. What is his
CPP?
a. 95mmHg
b. 45mmHg
c. 65mmHg
,d. 22mmHg
c. 65mmHgc.
CPP = MAP - ICP
Which of the following is true regarding diagnosing brain death?
a. The body temperature must be greater than 33c
b. A diagnosis of brain death can still be made if the child is receiving CNS depressants and
stimulants
c. Spinal reflexes may still be present
d. No solid criteria exist for diagnosing brain death in children
c. Spinal reflexes may still be present
The body temp must be > 36
The neurologist is assessing a child for brain death. When the head is turned from side to side, the
nurse notes that she has a "dolls eyes" response. In the neurologically intact child when the head is
turned rapidly from side to side the eyes should:
a. deviate to the opposite side that the head is turned to
b. deviate to the same side that the head is turned to
c. open and close in rapid succession
d. close tightly
deviate to the opposite side that the head is turned to
An apnea test is considered positive if which of the following are present?
a. Resp effort is made when the PCO2 > 60 mmHg
b. Resp effort is made when the PCO2 < 60 mmHg
c. No resp effort is made when the PCO2 > 60 mmHg
d. No resp effort is made when the PCO2 < 60 mmHg
, c. No resp effort is made when the PCO2 > 60 mmHg
It is also considered + if no resp effort despite rise in PCO2 20 mmHg above baseline
In addition to altering fluid and electrolyte balance, SIADH is a concern in the neurosurgical patient
because it can lead to:
a. Cerebral edema
b. Massive intravascular volume depletion
c. Cerebral hypernatremia
d. Altered level of consciousness
a Cerebral edema
SIADH causes hyponatremia which can lead to cerebral edema
The nurse is caring for a 12yr with hydrocephalus who is being evaluated for shunt malfunction.
Which of the following is considered to be an early sign of increased ICP?
a. Alteration in LOC
b. Changes in reactivity of pupils
c. Changes in RR
d. Changes in HR
Alteration in LOC
An alteration in LOC is considered to be the earliest sign of increased ICP.
Which of the following is a true statement concerning TBIs?
a. Concussions always involve loss of consciousness
b. Diffuse cerebral edema is due to decreased blood volume
c. Cerebral lacerations are often associated with skull fractures
d. Skull fractures are examples of secondary injuries
c. Cerebral lacerations are often associated with skull fractures
